Miscarriage and ectopic pregnancy admissions rise in recent years as stark inequalities persist, national study finds

Hospital admissions for miscarriage and ectopic pregnancy have increased in England in recent years, according to research presented today at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE).

The nationwide analysis also revealed persistent and substantial socioeconomic inequalities in early pregnancy complications that showed little sign of narrowing over the 20-year study period.

Miscarriage and ectopic pregnancy are among the most common complications of early pregnancy and can have significant physical, psychological and economic consequences. However, little is known about long-term national trends or how socioeconomic inequalities have changed over time.

The population-level analysis examined 786,984 miscarriage admissions, 211,727 ectopic pregnancy admissions and 12,418,745 deliveries recorded in England between 2004 and 2024.

The findings revealed notable changes in admission patterns over the two decades studied.

Between 2010 and 2018, miscarriage admissions declined significantly from 45,232 to 37,398 annually (Annual Percent Change [APC] −2.06%). A further steeper decline was observed between 2018 and 2021 (APC −4.26%), with annual admissions falling from 37,398 to 31,046.

However, admissions increased again in the post-COVID period (2021-2024), with 133,400 miscarriage admissions recorded over four years.

Whilst ectopic pregnancy admissions increased significantly between 2005 and 2012 (APC +2.81%), they remained relatively stable for several years before rising again between 2021 and 2024, when 44,577 admissions were recorded and a significant upward trend was observed (APC +4.28%).

Alongside changes in miscarriage and ectopic pregnancy admissions, the study found that deliveries declined. Annual deliveries fell from 636,401 in 2017 to 545,149 in 2024, representing a significant downward trend (APC −2.26%).

Lead author Sindhu Sekar, from the Department of Women's and Children's Health at the University of Liverpool and Liverpool Women's NHS Foundation Trust, said: “We were struck by the recent increase in admissions for both miscarriage and ectopic pregnancy. The reasons are likely to be complex, but changes in healthcare delivery during and after the COVID-19 pandemic, shifts in healthcare-seeking behaviour, increasing maternal age, rising obesity levels and broader reproductive health risk factors may all be playing a role.”

Persistent socioeconomic inequality was also observed. Over the most recent decade, miscarriage admissions totalled 71,104 among women in the most deprived decile, compared with 26,414 among those in the least deprived decile, representing an approximately 2.7-fold difference.

For ectopic pregnancy, 17,845 admissions occurred in the most deprived decile compared with 7,580 among those in the least deprived decile, a 2.4-fold difference.

Discussing the inequalities identified, Sekar explained: “The women most affected are often those facing the greatest challenges. Women living in more deprived communities are more likely to experience risk factors associated with pregnancy loss and face greater barriers to accessing care. These findings highlight how strongly reproductive health can be shaped by wider social and economic circumstances.”

Looking ahead, the researchers say improving reproductive outcomes and reducing inequalities will require action across both healthcare services and public health. Sekar said: “Ensuring equitable access to high-quality early pregnancy care should be a priority. Strengthening Early Pregnancy Assessment Units, improving care pathways and investing in prevention could help improve outcomes and reduce inequalities.”

On future research priorities, Sekar added: “Pregnancy loss has historically been overlooked and underfunded, despite affecting a large number of women and families. We believe it should be recognised as a major women’s health research priority. The next phase of research should focus on understanding causes, improving care, reducing inequalities and preventing avoidable pregnancy loss wherever possible.”

Commenting on the implications of the study’s findings, Professor Dr Anis Feki, Chair of ESHRE, said: “These findings are an important reminder that pregnancy loss and ectopic pregnancy are not only clinical events, but also reflect broader inequalities in women’s health. The recent rise in admissions deserves careful attention, and strengthening equitable early pregnancy care is a concrete way to improve outcomes and better support women and families.”

Reference:

Miscarriage and ectopic pregnancy admissions rise in recent years as stark inequalities persist, national study finds, European Society of Human Reproduction and Embryology, Meeting: ESHRE 42nd Annual Meeting.